Comparative occurrence of ischemic stroke with the rhythm versus rate control strategy in a national prospective cohort of atrial fibrillation

• Main Authors: Jae Guk Kim, Young Soo Lee, Ki-Woon Kang, Eue-Keun Choi, Myung-Jin Cha, Jung-Myung Lee, Jin-Bae Kim, Junbeom Park, Jin-Kyu Park, Tae-Hoon Kim, Jae-Sun Uhm, Jaemin Shim, Jun Kim, HyungWook Park, Changsoo Kim, Boyoung Joung
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2021-01-01
• Series: The Korean Journal of Internal Medicine
• Subjects: atrial fibrillation; rhythm; rate; stroke
• Online Access: http://www.kjim.org/upload/pdf/kjim-2019-063.pdf

Background/Aims Comparative occurrence of ischemic stroke for rhythm versus rate control strategy in patients with non-valvular atrial fibrillation (NVAF) is still inconclusive. The purpose of this study was to investigate whether the rhythm control strategy is associated with a lower risk of ischemic stroke compared to the rate control strategy in NVAF patients. Methods The CODE-AF registry prospectively enrolled 6,280 consecutive patients who were treated for NVAF at 10 tertiary referral centers in South Korea. Of these, 2,513 NVAF patients (age, 67 ± 10 years; male, 61.8%) were clinically followed up for over 1-year and divided into rate and rhythm control groups. Results Those treated with the rhythm control strategy were younger and had less proportions of underlying disease compared to those treated with the rate control strategy. After the propensity matching analysis, those treated with the rhythm control strategy had similar baseline characteristics including the CHA2DS2-VASC score compared to those treated with the rate control strategy. The rate of oral anticoagulation, all bleeding, and hospitalization were also similarly between the two groups. The incidence rate of ischemic stroke in the rhythm control group was significantly lower than in the rate control group (0.7 vs. 6.9 per 1,000 person-years, p = 0.011). Conclusions The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy.